Former psychiatric nurse vouches for home-based care for psychotic son
Brief, intensive home treatment for acute psychotic episode offers both patient, caregiver much-needed support
When Michele Martel talks about caring for patients suffering from acute psychotic episodes, she talks from professional experience – and from two decades of personal experience, looking after her adult son.
Richard Poulin, 42, has had psychotic episodes and periods of depression since he was in his early 20s. Until he began taking bi-weekly injections for his illness seven years ago, he spent an average of a month or two in hospital every year.
Martel, a retired nurse who worked in psychiatric care for 37 years, has been there for her son each time he relapsed.
Martel says as a parent, she doesn't feel she was taken seriously by her son's doctors.
Only twice in 20 years did her son's psychiatrist ask to meet her. Martel says when she asked to meet with the doctors, she was always told they were too busy.
"Well, I'm sorry, but the families have to be involved," she says.
This time, things are different.
Psychiatric team that makes house calls
Poulin is being treated under a unique program in Quebec which allows him to stay at home.
Traitement intensif bref à domicile (TIBD) is an award-winning initiative of the Institut universitaire en santé mentale de Québec, based in Quebec City. It provides intensive home care for patients in acute psychotic crisis as an alternative to in-patient treatment on a hospital psychiatric ward.
There's nothing therapeutic about being stuck between four walls with other people who are going through a crisis,- Richard Poulin, 42, psychiatric patient
The team, made up of 13 people, including nurses and social workers and one psychiatrist, goes to each patient's home – up to four times a day – 15 hours a day, seven days a week.
Before this latest round of treatment, Poulin feared being attacked. He would barricade his bedroom door at night and sleep with a knife.
He ended up in hospital, again. As a condition of his release, he agreed to be treated by the TIBD team.
Five weeks into the program, he's ready to swear by it.
"They [did a] miracle with my situation," he said, adding he's never responded so well to treatment before.
"I feel free," he says, "I feel cured now. I feel very good."
Poulin said if he'd had to stay in hospital to get through this latest acute psychotic episode, he doesn't think he would be well enough to be released yet. Being at home, with his cat and surrounded by his own possessions, is key.
Model that should be copied, mother says
"There's nothing therapeutic about being stuck between four walls with other people who are going through a crisis," Poulin said.
On the other hand, "there's nothing more therapeutic than being [among] your own things."
The program's annual budget is $1.3 million – most of that earmarked for salaries for the 13 staff.
Jean-Francois Beaulieu, the team's administrator, says it would cost at least twice as much if the patient's treated by the team were in hospital instead.
"In the last two years, we proved ... that this is a good way to treat people," Beaulieu said.
Within five years, he'd like to see two more intensive home-based treatment teams like this one set up in the Quebec City region.
Michele Martel, Poulin's mother, says if she were still working as a psychiatric nurse, she would want to work on a team with this home-based approach.
"This program should be put in place everywhere." she said. "People feel good about themselves in this program. They feel, 'Someone is thinking of me, someone is there to support me.'"
"On top of that," she adds, "they ask parents for their opinions."
For Martel, that's of utmost importance.
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